Successful awake proning is associated with improved clinical outcomes in patients with COVID-19: single-centre high-dependency unit experience. Issue 1 (14th September 2020)

• Record Type: Journal Article
• Authors: Hallifax, Rob J; Porter, Benedict ML; Elder, Patrick JD; Evans, Sarah B; Turnbull, Chris D; Hynes, Gareth; Lardner, Rachel; Archer, Kirsty; Bettinson, Henry V; Nickol, Annabel H; Flight, William G; Chapman, Stephen J; Hardinge, Maxine; Hoyles, Rachel K; Saunders, Peter; Sykes, Anny; Wrightson, John M; Moore, Alastair; Ho, Ling-Pei; Fraser, Emily; Pavord, Ian D; Talbot, Nicholas P; Bafadhel, Mona; Petousi, Nayia; Rahman, Najib M
• Is Part Of: BMJ open respiratory research. Volume 7:Issue 1(2020)
• Publication Date: 2020-09-14
• Subjects: respiratory infection -- non invasive ventilation -- viral infection; Respiratory organs -- Diseases -- Periodicals; Respiratory organs -- Diseases -- Treatment -- Periodicals; Respiratory therapy -- Periodicals; 616.2005
• DOI: 10.1136/bmjresp-2020-000678
• Languages: English
• ISSNs: 2052-4439

Abstract

Abstract : The SARS-CoV-2 can lead to severe illness with COVID-19. Outcomes of patients requiring mechanical ventilation are poor. Awake proning in COVID-19 improves oxygenation, but on data clinical outcomes is limited. This single-centre retrospective study aimed to assess whether successful awake proning of patients with COVID-19, requiring respiratory support (continuous positive airways pressure (CPAP) or high-flow nasal oxygen (HFNO)) on a respiratory high-dependency unit (HDU), is associated with improved outcomes. HDU care included awake proning by respiratory physiotherapists. Of 565 patients admitted with COVID-19, 71 (12.6%) were managed on the respiratory HDU, with 48 of these (67.6%) requiring respiratory support. Patients managed with CPAP alone 22/48 (45.8%) were significantly less likely to die than patients who required transfer onto HFNO 26/48 (54.2%): CPAP mortality 36.4%; HFNO mortality 69.2%, (p=0.023); however, multivariate analysis demonstrated that increasing age and the inability to awake prone were the only independent predictors of COVID-19 mortality. The mortality of patients with COVID-19 requiring respiratory support is considerable. Data from our cohort managed on HDU show that CPAP and awake proning are possible in a selected population of COVID-19, and may be useful. Further prospective studies are required.